Gamification in Rehabilitation of Patients With Musculoskeletal Diseases of the Shoulder: Scoping Review (Preprint)

Abstract

BACKGROUND Gamification has become increasingly important both in research and practice. Particularly in long-term care processes, such as rehabilitation, playful concepts are gaining in importance to increase motivation and adherence. In addition to neurological diseases, this also affects the treatment of patients with musculoskeletal diseases (MSD), such as shoulder disorders. Although it would be important to assist patients during more than one rehabilitation phase, it is hypothesized that existing systems only support a single phase. It is also unclear which game design elements are currently used in this context and how they are combined to achieve optimal positive effects on motivation. OBJECTIVE This scoping review aims to identify and analyze information and communication technologies using game design elements to support rehabilitation processes of patients with MSD of the shoulder. The state of the art with regard to fields of application, used game design elements, and addressed motivation concepts will be determined. METHODS We conducted a scoping review to identify relevant application systems. The search was performed in three literature databases: PubMed, IEEE Xplore, and Scopus. Following the PICO-framework, keywords and Medical Subject Headings for the aspects shoulder, rehabilitation and gamification were derived to define a suitable search term. Two independent reviewers, a physical therapist and a medical informatician, completed the search as specified in the search strategy. There was no restriction on years of publication. Data synthesis was done by a deductive-inductive coding based on a qualitative content analysis. RESULTS A total of 1994 articles were screened. 31 articles in English, published between 2006 and 2019 were included. All 27 described applications support patients with MSD of the shoulder in exercising, usually at home, but also in inpatient or outpatient rehabilitation clinics. Only two applications carry out a monitoring of adherence. Almost all applications are based on in-house developed software. The most frequently used game-components are points, tasks, and avatars. More complex game-components, such as collections and teams, are rarely used. When selecting game-components, patient-specific characteristics, here age and gender, are only considered in two applications. Most applications are described as motivating, an evaluation of motivation is, however, nearly not performed at all. CONCLUSIONS There are only a few applications supporting patients with MSD of the shoulder in rehabilitation by using game design elements. Almost all applications are exergames for supporting self-exercising. Applications for multiple rehabilitation phases seem to be non-existent. It is also evident that only a few complex game design elements are used. Patient-specific characteristic are generally neglected when selecting and implementing game-components. Consequently, a holistic approach to enhance adherence to rehabilitation is required supporting patients during the entire rehabilitation process by providing motivational game design elements based on patient-specific characteristics.